A GLOBAL LEADER IN APPLIED ADDITIVE TECHNOLOGY SOLUTIONS

A P P L I C AT I O N C U S T O M E R S T O RY:

The Jacobs Institute

SITUATIONThe mission of the Jacobs Institute (JI), located on the

Buffalo Niagara Medical Campus in Buffalo, New York,

is to accelerate the development of next-generation

technologies in vascular medicine. Physicians,

engineers, entrepreneurs and industry have

partnered in this one-of-a-kind medical innovation

center to speed the development of next-generation

technologies in vascular medicine for preoperative

surgical planning, training and education, and medical

device testing.

The JI has pioneered the development of 3D printed

neurovascular models to guide the development

of new devices and improve physicians’ ability to

treat cerebrovascular diseases such as strokes and

aneurysms. 3D printed models with compliant polymer

materials provide physicians, engineers and students

S T R ATA S Y S . C O M

Agilus30™ Improves Performance of Vascular Models

“Agilus30 allows us to simulate a range of patient disease states, such as plaque buildup, that were not possible with past materials. Its increased robustness also allows us to print smaller vessels so we can simulate procedures in the more distal cerebral anatomy. Finally, devices behave more realistically in the Agilus models than in models made of other materials.”

– Dr. Adnan Siddiqui, The Jacobs Institute

A vascular model 3D printed in Agilus30.

A P P L I C AT I O N C U S T O M E R S T O RY:

The Jacobs Institute

with anatomically accurate and clinically relevant

models of the vasculature within a patient’s brain.

The use of 3D printing in medical models has been

instrumental in enabling the JI to print patient-

specific pathologies for planning, educating

and testing.

Prior to 3D printing, the only medical models

available for this application were rigid models

or assembled silicone tubing, neither of which

are customizable or accurately mimic a patient

case. Pathology-specific 3D printed models aid in

testing prototype medical devices, planning for the

treatment of complex diseases, training students

and physicians in a realistic vascular environment,

and visualizing a patient’s anatomy prior to

treatment.

When testing a prototype medical device, 3D

printed models need to both simulate human

vasculature and be robust enough to withstand

30-50 device tests prior to degrading in order to

facilitate a comparative analysis of medical device

tools. This enables lifelike environments for testing

devices such as stentrievers, which are newly

developed clot retrieval devices credited with

revolutionizing stroke treatment.

Additionally, endovascular procedures require

the use of introducer sheaths that serve as

portals for physicians to transport medical

devices into patients’ vascular systems. Medium

to large sheaths pose a challenge for flexible

photopolymer 3D printing, resulting in frequent

tears as the sheaths translate and rotate with

very little clearance between the product and the

vessel wall.

These medical models function as more than just

visual representations of complex vasculature.

One of the common use cases involves training

a physician to retrieve a blood clot from a blood

vessel deep within the brain in order to treat a

stroke. This is challenging because once the

location of the clot is identified, it must then be

captured by a device and removed from the body

against the direction of blood flow. So, during

training, it is critical that the blood flows represent

An example of a clot in a 3D printed intracranial model.

AGILUS30 IMPROVES PERFORMANCE OF VASCULAR MODELS / 2

A P P L I C AT I O N C U S T O M E R S T O RY:

The Jacobs Institute

physiological conditions. In a 3D printed model,

this can be achieved by designing the vasculature

compliance of the 3D printed model and attaching

a pulsatile pump to the system.

In its early 3D printed models, the JI used

TangoPlus™ photopolymer for device testing

on the Stratasys Connex3™ 3D Printer. The

Connex3 is able to print 15um layers, and overall

tolerances between the target geometry and

printed geometry within 200um. TangoPlus

models provide lifelike haptic feedback, affording

physicians a realistic maneuverability within

the vasculature, especially as compared to

the previous standard – glass models – which

provided no compliance. Though successful

overall, TangoPlus has been prone to tearing,

ripping and leaking during post-processing and

use. Attempts to increase the wall thickness, by

adding shell-based reinforcements in higher stress

locations, and using higher durometer materials,

maintained the models’ clinical realism, but still

left a few challenges.

SOLUTIONStratasys, working closely with the JI, developed

the next generation of rubber-like PolyJet™

materials to enable more testing, easier cleaning

and greater tear resistance. Agilus30 improves

performance and realism of these complex

models. “Agilus30 allows us to simulate a range

of patient disease states, such as plaque buildup,

that were not possible with past materials. Its

increased robustness also allows us to print

smaller vessels so we can simulate procedures in

the more distal cerebral anatomy. Finally, devices

behave more realistically in the Agilus models than

in models made of other materials,” said Dr. Adnan

Siddiqui, chief medical officer at the JI.

3D printing complex vasculature with Agilus30

enables physicians to perform the entire

procedure under fluoroscopic image guidance

just as if it were a real endovascular intervention

using various medical devices including sheaths,

catheters, guidewires, stentrievers, flow diverters

This tear in an early version of a 3D printed model guided new material development.

AGILUS30 IMPROVES PERFORMANCE OF VASCULAR MODELS / 3

A P P L I C AT I O N C U S T O M E R S T O RY:

The Jacobs Institute

and embolic products. Contrast agents can be

injected through devices to image the phantom

vasculature using clinical techniques such as

digital subtraction angiography (DSA), roadmap

overlays for guidance and CT for 3D analysis.

In extensive testing, the JI has found Agilus30

offers superior results for the resolution for

complex shapes, intricate details and smooth

surfaces. More durable, rubber-like, tear-resistant

prototypes and models can stand up to repeated

flexing and bending. This makes the JI’s vascular

models more effective for surgical planning,

more lifelike for training and education, and more

durable for medical device testing.

RESULTSAs part of the development of this new material, a

thorough evaluation was performed to understand

how vascular models printed in the new Agilus30

compared to those printed in TangoPlus with

a specific focus on anatomical accuracy, tear

resistance, durability, haptic feedback and ease of

post-processing.

Agilus30 showed a similar anatomical accuracy

compared to TangoPlus. When comparing Agilus

intracranial models to TangoPlus models with the

same vessel thicknesses during cleaning, models

printed in Agilus30 consistently perform at a

higher level with respect to tear resistance and

A technician with a 3D printed intracranial model mid-cleaning.

X-ray road map of a model showing occluded right carotid artery (left side of image).

AGILUS30 IMPROVES PERFORMANCE OF VASCULAR MODELS / 4

A P P L I C AT I O N C U S T O M E R S T O RY:

The Jacobs Institute

overall durability than the TangoPlus models. The

Agilus30 models can withstand the methods

needed to clean out tortuous anatomies with

smaller, more angled vessels to a greater extent

than the TangoPlus model.

Post-processing cleaning time is reduced by

about one-quarter to one-half using Agilus30,

which avoids the ruptures that result in significant

repair time and possible leakages during use.

Also, because it is easier and more efficient to

clean the models, there is less room for variation

between technicians, which improves the

reproducibility of the models. Finally, the additional

robustness of Agilus30 allows for the design and

cleaning of more complex anatomies that would

otherwise be difficult.

Agilus30’s higher tear resistance and durability

have enabled the JI to create more life-like

simulations of arterial access, more tortuous

anatomies and the incorporation of atherosclerotic

vasculature, not before possible. By experimenting

with different vessel thicknesses, the JI has been

able to develop Agilus30 models that are more

robust than TangoPlus models, but that also

provide the desired compliance.

The innovation potential of the Agilus30 models is

considerable. These include anatomies with high

angulation, small vessels, many branches and

large blood pool models. This allows physicians to

train with larger and more complex anatomies for

presurgical planning, allows for the manufacturing

and prolonged use of anatomically accurate in

vitro models for product testing, and extends the

lifetime of models for use in physician training

and education. The 3D printing of vascular

models using Agilus30 enhances the JI’s ability

to accelerate next-generation technologies in

vascular medicine.

A 3D printed intracranial vasculature model printed with Agilus30.

AGILUS30 IMPROVES PERFORMANCE OF VASCULAR MODELS / 5

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A GLOBAL LEADER IN APPLIED ADDITIVE TECHNOLOGY SOLUTIONS